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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191592947
Report Date: 07/17/2023
Date Signed: 07/17/2023 04:26:57 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/14/2023 and conducted by Evaluator Bennette Pena
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20230714100240
FACILITY NAME:WOODRUFF CARE HOME INCFACILITY NUMBER:
191592947
ADMINISTRATOR:CARMEN GALICIAFACILITY TYPE:
740
ADDRESS:16409 WOODRUFF AVENUETELEPHONE:
(562) 925-6581
CITY:BELLFLOWERSTATE: CAZIP CODE:
90706
CAPACITY:88CENSUS: 65DATE:
07/17/2023
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Administrator, Gemma DeOsoTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Staff not maintaining a comfortable room temperature for residents.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced complaint visit regarding the above stated allegation. LPA met with Gemma Deoso, Administrator and explained the reason for the visit.

The investigation consisted of the following: LPA obtained copies of Resident & Staff Rosters, conducted a tour of facility such as common areas, focusing on the residents' rooms, Electrician's contact information and Resident #1 (R1) files such as; Identification and Emergency Information Sheets, Physician Reports, and Resident Appraisal. Between 2:03pm-2:48pm, LPA measured the room temperature using the infrared thermometer in (12) random residents rooms on the ground and 2nd floors, (Room numbers: 107, 110, 111, 113, 119, 126, 235, 236, 239, 240, 242 and 246). LPA also interviewed the Administrator, Staff #1 (S1) - Staff #3 (S3), and Resident #1 (R2) - Resident #10 (R10).
******CONTINUED ON LIC9099-C*****
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: David SicairosTELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Bennette PenaTELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 28-AS-20230714100240
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: WOODRUFF CARE HOME INC
FACILITY NUMBER: 191592947
VISIT DATE: 07/17/2023
NARRATIVE
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The investigation revealed the following:

Regarding allegation: “Staff not maintaining a comfortable room temperature for residents." It is alleged that the residents’ room was hot and uncomfortable and there is no air conditioning in some rooms. During today's visit, LPA toured the entire facility and observed that some resident’s rooms in the ground and 2nd floor have ceiling and stand fans, but no air conditioning. Between 2:03pm-2:48pm, LPA checked the room temperature in twelve (12) random residents’ rooms. Eight (8) out of twelve (12) rooms measured over 85 deg F.(room 107: 89 deg F, room 110: 86 deg F, room 119: 87 deg F, room 235: 86 deg F, room 236: 87 deg F, room 239: 86 deg F, room 240: 86 deg F, room 246: 91 deg F) which did not meet the Title 22 Regulations requirement. Interviews conducted with staff revealed that they have successfully installed portable a/c/s in (2) rooms, however they have not completed the work on other rooms due to an electrical panel breaker is still needed to be installed. Staff also stated that they are providing extra stand fans to the residents upon request and making sure that residents are hydrated by providing drinking water. Six (6) out of (10) residents interviewed stated that their rooms are hot and uncomfortable. Some residents stated that they like their rooms to be cooler and prefer to have air conditioning in their rooms because their rooms get very hot, especially during the day. LPA observed that rooms located in the south side of the building that were exposed to the afternoon sun are uncomfortable and have higher temperature readings than those rooms located in the west side.


Based on LPA’s observations and interviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Deficiency cited on the attached LIC 9099D.

An exit interview was conducted, and a copy of this report was provided to the Administrator, Gemma Deoso along with the Appeals Rights.

SUPERVISOR'S NAME: David SicairosTELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Bennette PenaTELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20230714100240
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: WOODRUFF CARE HOME INC
FACILITY NUMBER: 191592947
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/17/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/31/2023
Section Cited
CCR
87303(b)(2)
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87303 Maintenance and Operation ...
(b) A comfortable temperature for residents shall be maintained at all times.
(2) The facility shall cool rooms...between 78 degrees F (26 degrees C) and 85 degrees F (30 degrees C), or in areas of extreme heat to 30 degrees F less than the outside temperature.
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Administrator willl ensure that the facility shall cool rooms to a comfortable range (78-85 deg F) and agreed to install portable a/c to the rooms without a/c. Addiitonally, an electrician will install breaker panels designated for a/c only. Proof will be submitted to CCL/LPA by POC due date.
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This requirement is not met as evidenced by:
Based on observation and interviews, theAdministrator did not comply with the section cited above in which (8) out of (12) residents rooms measured over 85 deg F and (6) residents stated their rooms are uncomfortable because of hot temperature.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: David SicairosTELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Bennette PenaTELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2023
LIC9099 (FAS) - (06/04)
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